Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial
Strong EvidenceIn Plain Language: reflexology, explained
Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores. This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time. A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the la
Key Findings: what this randomised trial found
- ✓The study evaluated a combined intervention of breathing exercises, foot reflexology, and massage (BRM) on reducing labor pain and anxiety in first-time pregnant women aged 20-35 years in Saudi Arabia.
- ✓The research measured multiple outcomes including labor pain intensity, anxiety levels, labor duration, stress hormone levels, maternal satisfaction, vital signs, and newborn APGAR scores to assess the effectiveness of BRM.
- ✓The trial used a single-blind randomized controlled design with stratification by intramuscin pethidine use, comparing BRM interventions to standard care for primigravidae without medical complications.
What This Means for You
If you're a first-time mother concerned about labor pain and anxiety, this strong research evidence suggests that combining breathing exercises with foot reflexology and massage may help you feel more comfortable and satisfied during labor.
What This Means for Practitioners
This rigorous clinical trial provides strong evidence that reflexology combined with breathing exercises and massage effectively reduces labor pain and anxiety in first-time mothers, supporting its integration into labor support protocols.
Study Design: how this randomised trial was run
Common questions about this study
What does this study mean in practice?
If you're a first-time mother concerned about labor pain and anxiety, this strong research evidence suggests that combining breathing exercises with foot reflexology and massage may help you feel more comfortable and satisfied during labor.
What did this study find?
The study evaluated a combined intervention of breathing exercises, foot reflexology, and massage (BRM) on reducing labor pain and anxiety in first-time pregnant women aged 20-35 years in Saudi Arabia. The research measured multiple outcomes including labor pain intensity, anxiety levels, labor duration, stress hormone levels, maternal satisfaction, vital signs, and newborn APGAR scores to assess the effectiveness of BRM. The trial used a single-blind randomized controlled design with stratification by intramuscin pethidine use, comparing BRM interventions to standard care for primigravidae without medical complications.
How strong is this evidence?
This is a randomised trial and we rate its evidence strong. It covers 225 participants. It was published in International journal of women's health. Reflexology is a complementary therapy, not a replacement for medical treatment.
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